Fill out ADA dental claim forms in your browser

ADA claim forms, pre-treatment estimates, and insurance verification sheets — drop fields onto any PDF, fill it in and sign, free.

A dental front desk lives on the ADA Dental Claim Form — the 2024 revision — plus the pre-treatment estimates payers want before major work. Unlike medical billing it runs on CDT procedure codes rather than CPT, tied to specific tooth numbers and surfaces, and often needs a narrative explaining why a crown or extraction was necessary. This free tool opens the ADA form (or a payer's own version), lets you enter tooth numbers, CDT codes, fees, and that narrative exactly where they belong, sign it, and download a clean PDF to print or upload. It works in your browser alone, so patient records never leave the operatory.

Frequently asked questions

Does it use the current ADA dental claim form?+

Upload the 2024 ADA Dental Claim Form — or a specific payer's version — as a PDF and place fields for tooth numbers, CDT codes, surfaces, and fees. Any layout works because you position the fields yourself.

Can I fill in a pre-treatment estimate and the clinical narrative?+

Yes — the same tool handles pre-determination forms and gives you a free-text field for the narrative that justifies the procedure to the payer.

Do our patient records get uploaded?+

No. Everything is entered and rendered locally in your browser, so nothing about the patient or the treatment leaves the practice.

A claim for every patient?

dojobase can auto-fill dental claim forms from your practice-management data — one for every patient, without the typing.

Open the free Fill & Sign tool →